携带监测皮岛组合腓骨移植修复四肢长段骨缺损手术护理

目的 探讨带血管腓骨组合同种异体骨移植修复长段骨缺损手术的护理方法和效果.方法 回顾总结1994年1月～2007年12月27例因创伤、骨肿瘤、先天性假关节形成致骨缺损病人施行带监测皮岛组合腓骨移植手术的治疗及护理.术后加强对携带皮岛颜色、温度、弹性、毛细血管充盈、伤口渗液、疼痛、全身状况等指标的监测记录,注意患肢体位、功能锻炼,结合影象学检查结果评估移植的组合腓骨愈合情况.结果 有1例术后2 d监测皮瓣显示静脉危象,2例牙龈出血和鼻出血,16例受骨区伤口在7～22 d(平均12 d)出现不同程度的无菌性渗液,其中1例取出部分异体骨,加强换药处理后愈合.随访10～108个月(平均43个月),x线显示复合腓骨与自体骨骨性愈合;监测皮岛与周围皮肤正常愈合.结论 带监测皮岛的组合腓骨移植是修复长段骨缺损的好方法.皮岛血循环能及时了解腓骨血供和早期预测长段复合骨的转归;注意伤口渗液的观察和处理,防治感染和加强重建肢体功能锻炼是手术成功的关键.

Operation nursing for reconstruction of segmental bone defect in extremities using combined fibula transfer with skin island

Objective To investigate nursing methods and efficacy of segmental femur reconstruction using combined fibula transfer with skin island. Methods Between January 1994 and December 2007, 27 segmental bone defect reconstruction with combined fibula transfer with a skin island, caused by trauma, bone tumors and congenital pseudarthrosis were analyzed. Radiologic and clinical evaluations were performed on all patients. Postoperatively, the skin island should be checked periodically the color, capillary refill and even bleeding after needle prick. Results In one of them, cyanosis of the skin island was developed 2 days after surgery, and gum bleeding and nosebleed in 2patients. And aseptic exudate at recipient sites of 16 cases was occurred at 7 to 22 days ( average 12 days) after surgery, half of the massive allograft were taken out for continually wound effusion postoperatively in one case, and healed after regular dressing change. The follow-up time was ranged from 10 months to 108 months ( average 43 months), complete bony union of the fibula to the native bone in all cases with no fracture taking place, and all of skin island healed normally. Conclusions Use of combined fibula transfer with a skin island to reconstruct segmental bone defects of extremities can lead to earlier patient recovery and return of function. Skin island is a reliable method for assessing the vascular status of the grafted fibulae and predicting the prognosis for the combined bone transplantation. The key points for the success of operation are paying attention to observation and nursing for wound discharge, prevention of infection and strengthening functional exercise for affected extremity.